Provider Demographics
NPI:1477675015
Name:YERXA, JOHN D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:YERXA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 DE MOSS ST
Mailing Address - Street 2:
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-2618
Mailing Address - Country:US
Mailing Address - Phone:575-542-8384
Mailing Address - Fax:575-542-8367
Practice Address - Street 1:2743B HWY 35N
Practice Address - Street 2:
Practice Address - City:MIMBRES
Practice Address - State:NM
Practice Address - Zip Code:88049
Practice Address - Country:US
Practice Address - Phone:575-536-3990
Practice Address - Fax:575-536-3991
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2007-0006363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM300066OtherMEDICARE PTAN
NM57372764Medicaid
349719505Medicare PIN